Do I need ICU experience for FNP?

DaisyRN, ACNP · May 20, 2008

well, i'm a little partial to the acute care program myself... simply because that's what i did because i wanted an inpatient focus, too. but you need to check with your state board of nursing to verify you will be functioning within your scope of practice as an fnp by working in the hospitalist role. texas is turning away from allowing fnps in the "acute care" setting and will be eyeballing individual scopes and such in the near future. in an fnp program, you will be strictly focused on outpatient settings (or at least that's how utmb in galveston does it, and several others around here do it), so icu is irrelevant in the program... but by all means, if your state allows fnps to function in the capacity of a hospitalist, then i would say get as much icu/imc experience as you can... because i doubt you will get much in your program.

don't mean to rain on your parade... just don't want you to head down road you didn't intend to turn on. :)

best wishes!

djc1981 · May 20, 2008

Yes, I think you should try to get some ICU experience in if you can since you want to work in the hospital. But, no, it is not a requirement for most FNP programs. I actually think it may help you to go the FNP route. Around here, most hospitalist jobs don't specify ACNP (nearly every job doesn't put a requirement, or even specifically asks for FNPs). There simply isn't enough established to fill the need. Also, many hospitalist roles want you to be able to take care of minors if need be. If you choose ACNP, you will often have to choose between adults and peds AC. Thats very limiting imho. Unless you are sure you always want the hospitalist role with only adults or peds for the length of your career, I would be wary of picking something that could potentialing be so limiting in scope. :twocents:

DaisyRN, ACNP · May 20, 2008

yes, you are correct about acnps only being adult providers (unless you get pediatric post-masters)... but in several of the area hospitals here, the hospitalists do not see any pediatric patients. i just still think it is very important to verify with the state board because i would hate to spend all of the money and energy on something that could possibly not be allowed in the future. in another surrounding area, the fnps that were going to the hospital to round have been "strongly recommended" to get their acnp post-master's certificate or they will be spending most of their time in the clinic.

and yes, fnps are more generalized and often preferred, but when facilities find out about other specialty training, i.e. acnps, they tend to change their expectations. :) that happened to me at home, and we discussed this with hospital administrators from all over the u.s. in 2006 at one the aanp conference sub-groups. and now, the hospitalist group at home only allows the fnp employed with them (she was "grandmothered" in) to care for the nursing home/rehab patients that are stuck in the hospital. she cannot care for tele patients or acute care patients.

but, the purpose of my postings were just a warning because you are not trained to care for acute illness in a fnp program and that is what hospitalists care for. in my opinion, you are stepping into sketchy territory... because if you aren't trained for a particular area in your program, you aren't suppose to be able to practice in that area as an np. i'm not trying to downplay fnps either... we are all necessary to provide great patient care... it's just a different focus. and yes, you will still find fnps in the hospital that are very well-educated and knowledgeable about acute illness, but if you aren't "formally trained" for acute care, you shouldnt do acute care. just like i could not work in a family practice clinic.

just starting out on the road-to-np journey, these are things i would have appreciated knowing... this was actually my dilemma... fnp vs acnp... because i wanted pediatrics and inpatient. so, i sacrificed pediatrics for acute care... and i was thankful that my advisors acknowledged the potential limitations of the fnp route and working in the hospital, and knowing that i wanted to be in that environment (at least part time), they recommended the acute care program... and i am very grateful.

keyword of my postings: awareness, that's all.

core0 · May 20, 2008

Yes, I think you should try to get some ICU experience in if you can since you want to work in the hospital. But, no, it is not a requirement for most FNP programs. I actually think it may help you to go the FNP route. Around here, most hospitalist jobs don't specify ACNP (nearly every job doesn't put a requirement, or even specifically asks for FNPs). There simply isn't enough established to fill the need. Also, many hospitalist roles want you to be able to take care of minors if need be. If you choose ACNP, you will often have to choose between adults and peds AC. Thats very limiting imho. Unless you are sure you always want the hospitalist role with only adults or peds for the length of your career, I would be wary of picking something that could potentialing be so limiting in scope.

I think that this is very region dependent. I moved from a state that had a lot of FNPs working as hospitalists only to be told that the hospitals will no longer credential new FNPs for inpatient work. The hospital I currently work in has a fair amount of FNPs working in inpatient care but will no longer hire FNPs for inpatient work. The EM group I moonlight with does not hire NPs due to the ACNP not being able to see peds. The peds hospital across the street recently fired most of their FNPs. The ones that remain were told they have two years to get their PNP cert.

On the other hand TraumaRUs reports that FNPs are the preferred provider in the ER there. There are lots of reports of FNPs being able to get specialty medicine jobs without a problem.

The sense I get is that it is very region dependent. The more ACNP programs in the area and the more urban the area the more problems FNPs will have getting jobs outside of FP. On the other hand in very rural areas things happen in medicine that would never be allowed in a major medical center. The Southeast also seems to be more problematic (although this may be an issue of being more hostile to nursing). In the Southeast at least if the BONs are not enforcing the rules the lawyers seem to be happy to enforce them through expanding liability. While in your area you make look at the ACNP as limiting scope, in states such as Daisy's it is looked on as exceeding your scope of practice. The market is very different region to region.

David Carpenter, PA-C

djc1981 · May 20, 2008

Yes, I think it is definitely region dependent. We don't even offer an ACNP program in West Virginia. My personal family PCP is a FNP, but my dermatology PCP is also a FNP, as well as all the NPs in the nearby level one trauma hospital. Everyone just has to look at their own individual situation, geographic location and career goals when looking at specialization.

DaisyRN, ACNP · May 20, 2008

fnps in derm (or other specialists offices), pcp offices, or ers are common for reasons mentioned above, including the ability to treat pediatrics and the outpatient focus within the fnp program. and you're right djc, you have to look at geographic location, state requirements, and sort through your ultimate goals to figure out which program is best fitting for your area's need for midlevels and personal aspiration. i guess that's what my point was for blessedone... just to make sure that the state requirements, need, and personal desire were all leading down the same path.

nomadcrna, DNP, CRNA, NP · Jan 22, 2011

Thankfully, most states are not like Texas. Pretty idiotic to limit NP and their practice. The national organizations support being able to do what you can show you have training for. So an FNP can do hospitalist or intensivist or ER if they want. They may need to work "under" a mentor to learn initially or attend CEUs afterward.

I have full hospital admit privileges, cover the ER as a solo provider here in Alaska. It was the same in Montana as well.

nomadcrna, DNP, CRNA, NP · Jan 22, 2011

BTW, don't call NPs "mid-levels". We provide the same level of care and are judged the same as the physicians for our patient care. :)

carachel2 · Jan 22, 2011

I agree with the others, you need to find an ACNP program. Rumor has it that there is one FNP grad from our class who is working as a hospitalist NP. No way in double hockey sticks would I want an FNP caring for MY mom in an ICU. An ACNP, yes, but I'm just not seeing where this persons knowledge of vaccination schedules and NCEP guidelines is going to help him manage a critically ill patient in the ICU.

carachel2 · Jan 22, 2011

Thankfully, most states are not like Texas. Pretty idiotic to limit NP and their practice. The national organizations support being able to do what you can show you have training for. So an FNP can do hospitalist or intensivist or ER if they want. They may need to work "under" a mentor to learn initially or attend CEUs afterward.
I have full hospital admit privileges, cover the ER as a solo provider here in Alaska. It was the same in Montana as well.

I am VERY thankful that Texas is making this move. I am trained very, very well to manage patients in an outpatient setting. I think we had three days in a hospital following a hospitalist around. The ACNP program students were VERY well trained and had hundreds and hundreds of hours IN the hospital........I'm perfectly fine with them doing what they are trained to do. But in most programs, FNPs are NOT trained to provide acute care and should NOT be providing it without a lot of additional training.

criticalcareNP · Jan 22, 2011

I currently work in the hospital setting. I did my FNP and went back to school and got a post masters acute care certificate. I had to work an additional 500 clinical hours in the ICU setting. I have about 18 years of ICU and trauma ER experience. I feel very comfortable in the unit. I felt it was easier to go this route. I have heard for legal reasons many hospitals are going to having acute care trained NPs in the hospital.